Provider Demographics
NPI:1639491293
Name:ERNST, CURTIS (RPH)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:ERNST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:LYONS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13368-0265
Mailing Address - Country:US
Mailing Address - Phone:315-348-8121
Mailing Address - Fax:315-348-6120
Practice Address - Street 1:6805 MCALPINE ST
Practice Address - Street 2:
Practice Address - City:LYONS FALLS
Practice Address - State:NY
Practice Address - Zip Code:13368
Practice Address - Country:US
Practice Address - Phone:315-348-8121
Practice Address - Fax:315-348-6120
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
043288OtherNEW STATE PHARMACIST IDENTIFICATION NUMBER